First Visit by NP/PA and Second Visit by Doctor for same Injury in same group.

SaritaJP21

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Hello,

I am working on Worker's compensation project.Request to help me on below scenario;

For the work related injury first visit performed by Nurse practitioner(NP) or Physician Assistant (PA) and second visit performed by physician(Doctor) in the same group for same injury.Can we bill initial visits(9920X) twice, first time for NP/PA and second time for Physician ?Physician and Nurse practitioner both are working in same specialty.

Kindly guide on above scenario.
 

pscanlan

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Short answer is no, you cannot bill for a second new patient visit if the patient has already been seen by your group, regardless of what type of provider, as they are all the same specialty. They would all be conducting the same sort of initial examination. If it were a different specialty or subspecialty within the same group, THEN you could bill the second initial.

There's a handy decision tree for new/vs established patients at the front of the CPT manual, which is the basis of my answer. In the AMA 2019 Professional book (the one I have) it's on page 5.

Hope this helps.
 

SaritaJP21

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Request to guide me that, What can be the specialty of physician assistants ?In our group first visit is by PA only and second by Doctor.Please guide.
 
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